Payer Compliance Specialist

The Payer Compliance Specialist ensures adherence to payer requirements and internal compliance standards by supporting a claim-ready environment across operational teams. They drive audit readiness, reduce denials, and improve claim resolution through proactive communication, process review, and cross-functional collaboration. Responsibilities include supporting audit and compliance efforts by assisting with external payer responses, conducting internal reviews, and ensuring required training is completed. Maintaining payer setup and readiness including fee schedules, EFT/ERA configuration, portal access, and payer profile updates. Interpreting payer contracts and manuals to extract operational requirements and support clean claim submission. Maintaining up-to-date reference materials and serve as a resource to internal teams on payer rules and workflows. Monitoring payer updates and policy changes, assess their impact, and assist with implementation and compliance tracking; attending new payer orientation meetings and ongoing payer training sessions. Collaborating cross-functionally on special projects to improve payer compliance, documentation, and training systems.